More than 80% Indians experience the crippling back and leg pain. .Of these individuals 25% will have osteoarthritis while 35% will have mild spinal stenosis and 19% will have significant symptomatic stenosis (narrowing) of spinal canal. The condition mainly presents as part of the aging process, but the arthritis like condition also may appear in younger individuals. Back pain takes a toll not only on the patient, but also on his or her family and friends. Many patients find that along with their back health, their relationships slowly deteriorate as well.
Lumbar spinal stenosis occurs in the spinal column, where the spinal cord, nerve roots, and vertebrae are located. Over time, the spinal canal may become constricted or narrowed. This It is characterized by neurogenic claudicating i.e. heaviness / tingling in legs. It is exacerbated by walking and spinal extension.
Some patients have spinal stenosis due to slipped intervertebral disc. This commonly called as sciatica. Sciatica often associated with leg numbness or paresthesias and weakness in legs.
When it comes to open-back surgery, a patients age is an important consideration. Older surgical patients are more prone to having serious medical conditions, such as heart disease and diabetes, precluding them from undergoing open-back surgery. Older patients who undergo an invasive surgical procedure are more likely to suffer from an infection, life-threatening complication, or a return visit to the hospital within 30 days post surgery.
If patient has persistent neurogenic claudication (i.e. back pain, leg pain ,numbness and tingling made worse by sitting, bending and arching back) , or sciatica and has no relief of symptoms after 4-6 weeks of conservative management including rest and physical therapy then he is a candidate to endoscopic spine surgery.
If patient has medical problems like diabetes and heart disease that put him at a risk for general anesthesia then endoscopic spine surgery can be done under local anesthesia.
Endoscopic Discectomy is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients leg and back pain.
This minimally-invasive procedure is performed through a small tubular device. The surgery is performed under local or general anaesthesia, allowing the patient to leave the hospital the same day. After the disc protrusion is confirmed, a guide wire is inserted to the affected disc under fluoroscope guidance. A obturator tube is passed over the guide wire to push apart the tissue down to the disc and to move the nerve root out of the way. The working sleeve, through which the surgery will be performed, is slid over the dilating tube. The guide wire and dilator are then removed. The surgeon uses instruments to remove degenerative and extruded portions of the disc nucleus. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable. The foramen and nerves are inspected to confirm successful decompression. The instruments and sleeve are removed. Because no muscles or bone are cut during the procedure, recovery is fast and scarring is minimized. The patient may need a day of bed rest after the procedure and physical therapy.
Can be done under local anesthesia and sedation.
One day hospital stay.
No risk of General anesthesia i.e safe in patients with medical problems like heart disease, diabetes and with advancing age.
Predictable relief of back and leg pain.
Although age is a consideration for most surgical procedures, it is less a determinant for endoscopic surgery. Rather than performing a laminectomy to completely remove the lamina, endoscopic procedures perform a laminotomy or partial removal of the lamina, which preserves more of the lamina and decreases the odds of spinal instability in future years. According to the peer-reviewed journal articles, science is on the side of minimally invasive spine surgery, touting it as a safe and effective alternative to open-back surgery for older adults. Many surgeons and medical practices are slowly migrating toward adopting this technique. The endoscopic technique is a permanent solution for many patients that allow them to preserve mobility and return to their routines and favourite activities. Patients with back problems can thus benefit from endoscopic spine surgery.